1 A acarboseL❙ L(ah-car-bose) Prandase , Precose

CLASSIFICATION INDICATION/ROUTE/DOSAGE Clinical: Antidiabetic mellitus 1 Pharmacotherapeutic: Alpha-glucosidase inhibitor Oral: Adults, elderly: Initially, 25 mg ( ⁄2 a 50 mg ) 3 times/day at the start (with first bite) of each main meal. Range: 50–100 mg 3 times/day. Maxi- PREGNANCY/LACTATION mum: <60 kg: 50 mg 3 times/day; >60 kg: 100 mg 3 times/day. Category B: , rather than oral agent, is drug of choice during pregnan- cy. Unknown if drug crosses placenta or is distributed in breast milk. PRECAUTIONS Contraindications: Significant renal dysfunction (serum creatinine AVAILABILITY (Rx) >2mg/dl), hypersensitivity to drug, diabetic ketoacidosis or cirrhosis, inflam- Tablets: 25 mg, 50 mg, 100 mg matory bowel disease, colonic ulceration, partial intestinal obstruction or pre- disposition to intestinal obstruction, chronic intestinal diseases associated ONSET PEAK DURATION with marked disorders of digestion or absorption, conditions that may deterio- rate as result of increased gas formation in the intestine. Cautions: Malnour- Oral — 1 hr 12–24 hrs ished, or debilitated, those with renal or hepatic dysfunction, cardiac disease. Increased risk for when given in combination with insulin. Absorption not necessary for therapeutic effect. Metabolized by intestinal digestive enzymes/microorganisms. Elimination occurs through renal and INTERACTIONS fecal route. Half-life: 2.7–9 hrs (increased in impaired renal function). DRUG: Digestive enzymes, intestinal absorbents (e.g., charcoal) reduce acar- bose effect. Do not use concurrently. may produce hypo- ACTION/THERAPEUTIC EFFECT glycemia. Diuretics, corticosteroids, phenytoin, sympathomimetics, Delays absorption and digestion of , resulting in smaller phenothiazines, nicotinic acid, thyroid hormones, estrogens, oral contracep- rise in blood glucose concentration after meals, lowering postprandial hyper- tives, calcium channel blockers, isoniazid may produce . glycemia. Does not enhance insulin secretion. FOOD: None significant. LAB VALUES: May increase serum transaminase USES levels and slightly reduce Hct. Use either alone or in combination with a , insulin, or SIDE EFFECTS to lower blood glucose in pts with mellitus when diet plus FREQUENT: Transient GI disturbances: (77%), (33%), either acarbose or a sulfonylurea do not give adequate glucose control. abdominal pain (21%). Symptoms tend to diminish in frequency and intensity ADMINISTRATION/HANDLING over time. Oral ADVERSE REACTIONS/TOXIC EFFECTS • Give with the first bite of each main meal. None significant. • Store at room temperature, avoid moisture.

© 2001 W.B. Saunders Company

NURSING IMPLICATIONS Patient/Family Teaching: Carry oral glucose (dextrose) instead of cane Baseline Assessment: Question for hypersensitivity to acarbose. Check () for immediate response to hypoglycemic episode. Prescribed diet is blood glucose level. Discuss lifestyle to determine extent of learning, emotion- principal part of treatment; do not skip or delay meals. Diabetes mellitus requires al needs. Assure follow-up instruction if pt/family do not thoroughly under- lifelong control. Check blood glucose/urine as ordered. Serum transaminase lev- stand diabetes management or glucose-testing technique. els should be checked q3mos during first year of treatment and periodically there- Intervention/Evaluation: Monitor blood glucose and food intake. Monitor liver after. Wear medical alert identification. Check with physician when glucose function, glycosylated Hgb. Assess for hypoglycemia (cool, wet skin, tremors, demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity). dizziness, anxiety, headache, tachycardia, numbness in mouth, hunger, diplop- Avoid alcoholic beverages. Do not take other medication without consulting ia) or hyperglycemia (polyuria, polyphagia, polydipsia, nausea, vomiting, dim physician. Weight control, exercise, hygiene (including foot care), and nonsmok- vision, fatigue, deep rapid breathing). Check for adverse skin reactions, jaundice. ing are essential parts of therapy. Protect skin, limit sun exposure. Avoid exposure Monitor hematology reports. Assess for bleeding or bruising. Be alert to condi- to infections. Select clothing, positions that do not restrict blood flow. Inform den- tions that alter glucose requirements: fever, increased activity or stress, surgical tist, physician, or surgeon of this medication before any treatment. procedure. Lifespan Considerations: Safety and efficacy in children not established. No special considerations for the elderly.